Guide to Pre-Pregnancy, Pregnancy, Postpartum and Breastfeeding
Pre-Pregnancy
Prenatal Vitamins
It is important to take a daily prenatal; up to 80% of women who do not supplement become deficient in a necessary nutrient. Not all supplements are created equal. Continue to work with your health-care provider, and here are some general nutrient guidelines during pregnancy:
Methyl Folate or Folinic Acid, not folic acid, at least 800mcg
Low levels of folate may increase risk of miscarriage/birth defects.
Vitamin B12 should be taken in the form of methylcobalamin, adenosylcobalamin or hydroxocobalamin, never as cyanocobalamin. The “cyano” form contains cyanide.
Iodine: minimum daily intake of at least 150mcg.
Essential to make thyroid hormone, which regulates the growth and metabolism of all tissues.
Iron: minimum daily intake of at least 18mg.
Iron deficiency can impair development of the placenta, reduce infant growth and increase the risk of poor pregnancy outcomes.
Omega 3 fatty acids, or “Fish oil” 1000-2000mg of DHA and EPA daily.
Triglyceride form only, not ethyl ester form, to ensure bioavailability. Ethyl ester forms are cheaper and are cleaved to alcohol in the GI tract, making them additionally unsuitable.
Key for fetal brain development, prevents postpartum depression.
Vitamin D3, serum goal is 50-80, dose is dependent on lab value, can range from 1000-5000 IU as cholecalciferol or D3, best absorption when combined with Vitamin K.
Check levels, can be done through Quest/Labcorp.
Low levels are associated with increased risk of preeclampsia and gestational diabetes.
Other Suggestions:
Eat whole eggs for choline.
Use iodized salt for iodine.
Eat organic whenever possible.
Avoid bisphenol-A and foods wrapped in plastic.
Pregnancy
Nausea and Vomiting
Occurs before 9 weeks and often resolves by 14 weeks.
Lifestyle Recommendations
Increase sleep and rest. The most fatigue = more nauseous.
Mild to moderate: Low impact exercise may reduce symptoms.
Nutrition:
Eat something immediately upon awakening. Then every 2 hours. High protein and high fiber meals are best.
Low glycemic helpful but can be challenging.
Examples of Low glycemic carbs include: sweet potatoes, steel cut oatmeal, berries/apples, beans/legumes.Taking a MVI (multivitamin) prior to pregnancy or before 6 weeks decreases chances of NVP (nausea and vomiting of pregnancy), take with dinner or at bedtime.
Botanicals and Supplements:
Ginger (Zingiber officinale): safe, well studied. Takes 3 days to work. Affects serotonin receptors in the GI tract.
250 mg powdered ginger in capsules four times daily, or 500 mg twice daily.
Ginger can be consumed in many forms, including as a food, candied, or an infusion (tea). To make a tea, use 1 teaspoon of grated fresh ginger root in 1 cup of hot water, and drink approximately 3 cups a day; dried leaves can also be used.
Precautions: Do not take more than 2g/day to avoid an anticoagulation effect. Ginger may cause heartburn if large doses are taken on empty stomach. Ground ginger rhizome/root is preferred, avoid highly concentrated ginger extracts.
Chamomile (Matricaria chamomilla): considered very safe, not well researched
Drink as a tea throughout the day.
Chamomile should be used with caution in patients who are allergic to ragweed and daisies.
Peppermint Leaf (Mentha piperita): relaxes smooth muscle in the bowel.
Drink as tea: 2 to 3 cups or as candies/gum.
Peppermint oils or supplements have not been studied, may increase reflux symptoms.
Vitamin B 6 (Pyridoxine) 25 to 50mg three times daily.
water soluble vitamin, very effective for nausea.
Active form: P5P (pyridoxal-5-phosphate, most effective form).
Do not take more than 1000mg/day to avoid sensory neuropathy.
Food sources: poultry, fish, shrimp, lentils, seeds/nuts avocados, bananas, carrots.
Alternative Therapies
Acupressure and Acupuncture
Acupressure is free; can apply band with bead to acupuncture point for passive stimulation with effect.
Hypnosis: several clinical trials indicate efficacy, visualization exercises can be led by professional or self-directed.
Headache
Most common during 1st and 3rd trimester. Sleep, hydration and caffeine withdrawal can contribute. Poor posture and muscle tension from carrying the baby.
Lifestyle Interventions
Ensure adequate fluid intake.
Avoid caffeine.
Gentle daily movement.
Botanicals and Supplements
Magnesium glycinate, 100-500mg per day. Take 1 hour prior to bedtime.
Alternative Therapies
Acupuncture – wonderful for headaches!
Massage – after 1st trimester
Chiropractic care – find a provider who is experienced with pregnancy
Aromatherapy – lavender works well for headaches (use after the 1st trimester only)
Constipation
Can occur starting in 2nd trimester as progesterone levels increase. This reduces or slows transit time in the GI tract.
Lifestyle
Continue with movement, yoga, walking, etc. to help maintain gastric motility
Increase fluids (goal is 8-10 glasses of water daily)
Increase fiber intake (goal is 25-30 grams daily)
Bulks stool for more regular bowel movements.
Feeds and supports good bacteria in colon.
Regulates blood sugar.
Gradually increase fiber to avoid bloating and gas.
Nutrition
Increase dietary fiber: go slow to avoid bloating and gas. Goal is 20-25 grams daily.
Fiber rich foods.
Dried fruit: 1 cup prunes or dates (12g).
Fruit: 1 large apple or pear (5 g), ½ cup raspberries (9 g).
Nuts and Seeds: 2 Brazil nuts (2.5 g), 23 almonds (3.5 g).
Vegetables: 1 cup peas (16 g), 1 artichoke (10 g), 1 cup cooked broccoli (5 g).
Legumes: 1 cup black beans (15 g).
Add ground flaxseed (2 g per 1 tbsp) or chia seed (10 g per 1oz) to yogurt, cereal and salads.
Botanicals/Supplements
Ginger- great prokinetic and can speed up GI transit time
200mg dried ginger in clinical trial increased gastric emptying.
Ginger tea is also a great remedy.
Probiotic - 10 billion per capsule containing combination of Lactobacillus and Bifidobacterium species
May relieve constipation and improve regularity of bowel movements.
Also shown to decrease allergies and eczema in infants born to mothers who took probiotics during 3rd trimester.
Magnesium glycinate 500mg per day max dose.
Also helps with sleep, anxiety, back pain, leg cramps
Preventing Urinary Tract Infection
Risk of urinary tract infections increase during pregnancy due to increased bladder volume and decreased bladder tone. This can lead to urinary stasis and reflux.
Lifestyle
Urinate after sexual intercourse to decrease UTI occurrence.
Increase fluid intake.
Botanicals/Supplements
Cranberry (Vaccinium macrocarpon) prevents adherence of E.coli to urinary epithelium and reduces incidence of UTI.
Dose 4oz cranberry juice 2 times daily or 400mg cranberry extract twice daily
Heartburn
More than half of all women experience heartburn during pregnancy. It is most common during 2nd and 3rd trimesters. Progesterone relaxes the lower esophageal sphincter allowing acid to come back up into the esophagus. Growing uterus puts additional pressure on stomach pushing acid upwards.
Lifestyle
Eat small meals
Eat slowly
Pause and take several slow deep breaths prior to eating - practice mindful eating to stimulate digestive enzymes and increase blood flow to the gut.
Do not eat before bed or laying down: gravity may increase movement of acid up into the esophagus.
Avoid caffeine, spicy foods and tomato products: irritating, can trigger symptoms.
Botanicals/Supplements
Calcium citrate - decreases burn of reflux
Dose: chewable form, 300-400mg, 1-2/day max.
Slippery Elm: Very effective herb for sore throat and heartburn.
Dose: 1-2 Lozenges or chewable tablets as needed.
Low Back Pain and Abdominal Cramping
As the uterus grows, round ligaments in the abdomen stretch and may be painful. Two Thirds of women experience back pain during pregnancy.
Important to see your provider to rule out other causes of pain (miscarriage, UTI, ectopic pregnancy, etc.).
Lifestyle
Rest, avoid heavy lifting.
Apply heat.
Pelvic tilt exercises- Slowly lift and lower hips. Try lowering back to the ground one vertebrae at a time.
Supplements and botanicals
Chamomile (Matricaria chamomilla): flowering plant, considered very safe, not well researched, decreases cramping.
Drink as a tea throughout the day.
Chamomile should be used with caution in patients who are allergic to ragweed and daisies.
Red Raspberry Leaf tea: promotes uterine tone and can decrease cramping.
2-4 cups per day.
Alternative Therapies
Acupuncture
Chiropractic - may be helpful at maintaining alignment.
Physical Therapy: pelvic floor physical therapy, works to support internal pelvic muscles which can become too tight or relaxed.
Massage: after 1st trimester, massage during pregnancy also can decrease rates of postpartum depression.
Anxiety
Common throughout pregnancy. It is an exciting time but full of changes, transitions and unknowns. Sleep can be disrupted by anxiety, discomfort and/or frequent urination.
Lifestyle
Avoid caffeine and high sugar foods.
Healthy sleep habits:
Avoid screens (phones, computers, TVs) 30-60 prior to bedtime: Blue light stimulates brain to wake up, mimics morning time.
Dark and cool room (68 degrees optimal).
Have a schedule.
Incorporate a Mind Body practice: A 2008 review of studies on mind-body interventions in pregnancy practices, including breath work and yoga, found that they resulted in higher birth weights, shorter labors, fewer instrument-assisted births, and a reduction in the mother's perceived stress and anxiety
4-7-8 breath
Mindfulness: free apps Calm, Headspace.
Guided imagery: Listen to a recorded voice or music, can be done at bedtime, stimulates relaxation response. Good resources are Kaiser Permanente, www.healthjourneys.com.
Botanicals/Supplements
Omega 3 Fatty Acids: anti-inflammatory action, DHA Makes up 20% of fatty acids in brain but is not produced by the body so must be obtained by diet or supplementation. Pregnant mothers’ levels decrease substantially during pregnancy and remain low 9-12 months postpartum if not supplemented.
Dose: triglyceride form, 1-2 grams of EPA/DHA.
Supports mom’s mood including anxiety and depression.
May decrease risk of postpartum depression by up to 50%.
Supports immune system and brain health of infant.
German Chamomile (Matricaria chamomilla): quiets and calms, promotes relaxation, helps you to fall asleep
Drink as tea throughout the day.
Magnesium glycinate: Helps with sleep and anxiety.
Dose: 400-500mg per day max dose.
Take 1 hour prior to bedtime.
Aromatherapy
After the 1st trimester.
Ultrasonic diffuser or diluted in carrier oil.
Lavender is helpful for relaxation, sleep, nervousness and headaches.
Postpartum and Breastfeeding
It is always a good idea to consult with your obgyn, midwife, pediatrician and/or lactation consultant on any changes to your treatment plan.
Postpartum Herbal Sitz Bath
Herbs like Calendula, Comfrey, and Lavender are soothing in a post-partum herbal sitz bath. More herbs and places to get them are listed here: https://twincitiesmidwifery.com/postpartum-herbal-sitz-baths/
Herbs Safe for Breastfeeding
From our previous blog, Should I Take Herbs While I’m Breastfeeding? (Part 1), Dr. Tetlow writes:
“Women around the world have traditionally relied upon herbal medicine to address specific concerns when they are lactating. Scientific evaluation has not been undertaken for the vast majority of these herbs but a number are often widely recommended. Herbs commonly mentioned in the herbal literature for enhancing the production of breast milk (lactagogues) include aniseed, borage, caraway seeds, cinnamon, comfrey, dill, fennel seeds, fenugreek, goat’s rue, marshmallow, milk thistle, blessed thistle, nettles, raspberry leaves, as well as chastetree. Aniseed, caraway seeds, cinnamon, dill, and fennel seeds are all aromatic spices that can be easily and safely added to foods. Raspberry, nettle, marshmallow and fenugreek are quite benign and can be consumed in tea by nursing mothers if they choose.”
Additionally, the nettles can help replenish iron in your body and the raspberry leaves can help your uterus shrink back to pre-baby size after birth.
Herbs Unsafe for Breastfeeding
To learn which herbs are unsafe during breastfeeding, read Part 2 of the blog: Which Herbs are Unsafe During Breastfeeding (Part 2).
No one will test a pregnant person- thank goodness!- so there’s some herbs we will never know if they are completely safe- always talk with your obgyn, midwife, and pediatrician for their recommendations.
PIM wants to hear from you! Do you have an experience with any herbs, lifestyle changes, or remedies throughout pre-pregnancy, pregnancy, postpartum and breastfeeding? Do you find this article helpful? Have questions about specific herbs? Share your thoughts or questions in the comments below or on our Facebook and Instagram!
Are you looking for a more comprehensive, empowering approach to medicine? Schedule a 20-minute free consultation with Lynda Sherland, CRNP, FNP-C or Veronica Porterfield, PA-C today! Not quite ready to schedule and have questions? Quickly get in touch with us today!
Are you suffering from the effects of ongoing stress, mood or hormone imbalance, including thyroid imbalance, or are you already working with a doctor to address a condition but want a more comprehensive, empowering approach to medicine for yourself or a loved one? Schedule a 20 minute free consultation or an appointment with Veronica Porterfield, PA-C or Lynda Sherland, CRNP, FNP-C today! Not quite ready to schedule and have questions? Quickly get in touch with us today!
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Maizes, MD, Victoria, and Tieraona Low Dog, MD. Integrative Women's Health. New York: Oxford U Press, 2010. Print.
Rakel, David. Integrative Medicine. 3rd ed. Philadelphia: Saunders, 2003. Print.
Schulz, Volker. Rational Phytotherapy: A Reference Guide for Physicians and Pharmacists. 5th ed. Berlin: Springer, 2004. Print.
Vieten, Cassandra. Mindful Motherhood: Practical Tools for Staying Sane During Pregnancy and Your Child's First Year. Petaluma, Calif.: Noetic, Institute of Noetic Sciences, 2009. Print.